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∞ ∞ ∞ Ь Ь Ь Ь Ь Ь €€€€ Falls Amongst The Elderly Can't Be Ignored
Posted by HYPERLINK "http://www.nursinghomesabuseblog.com" Jonathan Rosenfeld on November 08, 2008
John Leland of HYPERLINK "http://nytimes.com" The New York Times, wrote a great piece addressing falls amongst the elderly.† Once thought to be an inevitable part of growing old, falls are frequently the result of underlying medical problems.† Equally important, is the fact that post-fall care must be given priority to avoid medical and psycological problems.† After reading this aticle, you will come to realize that there really is no such thing as a 'minor fall' amongst the elderly population.
Once considered an inevitable part of aging, falls are now recognized as complex, often preventable events with multiple causes and consequences, calling for a wide range of interventions, both psychological and physiological, that many patients never receive.
Even falls that cause only minor injury Уneed to be taken as seriously as diabetes,Ф said Dr. R. Sean Morrison, a professor of geriatrics and adult development at Mount Sinai School of Medicine in New York, because Уthey can be a real warning sign that something serious is wrong.Ф
Dr. Mary E. Tinetti, a falls expert at Yale University medical school, compared falls to strokes in their harmfulness, adding that people do not always report them or seek help, for fear their families will try to put them in nursing homes. For some people, Dr. Tinetti said, admitting that they fall is tantamount to admitting that they are no longer competent to take care of themselves.
Each year, 1.8 million Americans over age 65 are injured in falls, according to the Centers for Disease Control and Prevention. Some rebound as if the injury never happened. But for some, the fall sets off a downward spiral of physical and emotional problems Ч including pneumonia, depression, social isolation, infection and muscle loss Ч that become too much for their bodies to withstand.
In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a direct result of the fall. Less visible are the many who survive the fall but not the indirect consequences.
When first interviewed in mid-July, Ms. Aliminosa and Ms. Arnold felt vulnerable and constrained, their world diminished. Both had led accomplished professional lives Ч Ms. Arnold as a school psychologist, Ms. Aliminosa as a medical researcher Ч and had been active in the communityТs independent living apartments. But neither could be confident about what the future held.
Ms. Aliminosa said she was depressed, and able to walk only in very small stretches. A small woman with a soft voice and grainy New York accent, she barely filled her chair. She seemed defeated. УEmotionally I have not been well,Ф she said. УItТs made me very aware of my age, and thatТs hard to accept.Ф
Ms. Arnold, by contrast, was full of emotional energy, so angry about her broken hip that she kicked out for emphasis as she talked, turning conversation into a full-contact sport. Before her fall, she had been preparing for a vacation with her daughter at a family beach house on Long Island Ч the same house where she had spread her husbandТs ashes. Now that plan was gone.
УIt kills me, it just kills me,Ф she said. УThis was going to be the frosting on the cake, and somebody ate it.Ф
Of the two women, Ms. Arnold was up against the longer odds. One in five hip-fracture patients over age 65 die within a year after surgery, according to the C.D.C.; one in four have to spend a year or more in a nursing home. When younger people fall, they tend to break their wrists catching themselves, but in older people, who have slower reactions and less upper-body strength, the weight more often falls on their hips or heads. Any underlying conditions, like heart disease or respiratory problems, increase the chances of a downward health spiral.
Ms. Arnold had a history of pulmonary disease, and had been a heavy smoker, starting after high school. УShe had a boyfriend in college,Ф her daughter, Margery Creek, said, Уand it was the lesser of evils Ч sex, drinking or smoking.Ф
But her lung problems did not keep her down. In 2006, she took a 10-day trip to Sweden. Even after she fell and fractured a hip that autumn, she lived independently and was able to drive, returning to the beach house. That day in mid-July, even as she talked about depression, she took jubilant delight in photographs of her grandchildren and great-grandchildren. УNow if that isnТt the picture of a baby,Ф she said. УIsnТt she a sweetie?Ф
If Ms. Arnold were a machine, it would be simple to draw a straight line between her lung disease, her hip surgery and her chances of recovery. Older bodies typically have several weakened systems that are dependent on one another, and rely on drugs that may or may not work well together. УIf you take 70-year-olds, on average theyТre taking five medications,Ф Dr. Tinetti said. УWhen you get to 10 medicationsФ Ч as a patient might after a fall Ч Уthe likelihood of adverse effects is close to 100 percent.Ф
But psychological factors can be as devastating as the physical trauma, Dr. Tinetti said. УItТs the fear of falling, the lost confidence. Good walkers stop walking, stop going to church. They become socially isolated and depressed.Ф
After Ms. ArnoldТs first broken hip, she had reduced feeling in one foot, which added to the likelihood that she would fall again.
On July 6 this year, it happened: Ms. Arnold turned her body without moving her foot, pulling the closet door down with her when she fell and fracturing her hip bone.
УIТm outraged,Ф she said a week after the fall, raising her voice and then becoming fatigued. Her breathing was interrupted by coughing spasms. She said she was determined not to end up using an electric cart. УDisappointment,Ф she said, accenting each syllable. УI had a very good life.Ф
УBut your life isnТt over,Ф said Deanna Gray-Miceli, an adjunct assistant professor of nursing at the University of Pennsylvania and an expert in geriatric falls who was looking in on Ms. Arnold in the nursing unit.
УWell, it bloody well is,Ф Ms. Arnold said. УI have no strength. LetТs talk about depression.Ф
The period of immobility after a fall is particularly dangerous, said Dr. Gray-Miceli, whose research includes studying a group of patients after falls. УBeing immobile, youТre not taking deep breaths, youТre more prone to orthostatic pneumonia, or older people can develop urinary incontinence. And that can have a whole cascade of emotional consequences as well as the physical consequences, such as skin breakdown, pressure sores, bladder infection, lung infection.
УWe also see temporary confusion from infection,Ф she added, УAnd that can lead to someoneТs demise.Ф
Dr. Gray-MiceliТs work focuses on identifying the causes of falls, which might include treatable factors like changes in gait, low blood pressure, declining vision or heart arrhythmias, as well as conditions in the home. In a study by Dr. Tinetti, simple preventive suggestions from doctors, like physical therapy and changes in medication, reduced falls by 11 percent. (The C.D.C. offers tips to reduce falls at home, like removing loose rugs and making sure stairway handrails go all the way to the bottom, at cdc.gov/ncipc/duip/preventadultfalls.htm.)
For Ms. Arnold, it was too late. Shortly after surgery she grew depressed and fatalistic, her daughter said. УOne morning when my brother was here, she woke up and said, СIТm weary, IТm just absolutely weary,Т Ф Mrs. Creek said. УAnd she had no muscle that came back. Her arms had really gotten down to skin and bones. You hear that term Ч it certainly seemed that way, no muscle.Ф
In August, Ms. Arnold developed pneumonia and spent three nights in the hospital. Though she responded well to the medications, Mrs. Creek said: УIt was just one more nail. She said she was ready to be with Dad.Ф
The last time Mrs. Creek called her, in early September, Ms. Arnold could recognize her voice but not respond, Mrs. Creek said. УI think she just said, СIТve had it, IТm checking out.Т Ф
Down the hall, Ms. AliminosaТs response after her leg fracture was just as unpredictable.
On April 4, she was enjoying a visit from two favorite nieces Ч Ms. Aliminosa never married Ч when she found herself on the floor of her apartment, she said. She had no memory of how she fell.
Ms. Aliminosa has osteoporosis and a history of falling, so she told her relatives not to touch her until the nurses came. She needed a metal rod in her leg and began a slow process of physical rehabilitation. She said the falls were the first thing that made her feel old. УIТd love to be able to have dinner and take a short walk, and I canТt do that,Ф she said.
Because she was in a full-spectrum medical facility, her care was well coordinated, said Dr. Albert Siu, a professor and chairman of geriatrics and adult development at Mount Sinai.
УFor example, osteoporosis is often at root of this,Ф Dr. Siu said. УBut in a three-day hospital stay, addressing osteoporosis is not at the top of everyoneТs mind. There itТs dealing with the pain, the complications and the repair of the fractured hip.Ф Medications for blood pressure or pain might increase dizziness or chance of falls. In mid-July, while Ms. Arnold was angry but relatively mobile, Ms. Aliminosa seemed resigned to a loss of mobility and independence. The prospect weighed heavily on her. When asked if she had considered counseling for depression, she said she did not think she could bear talking about it. УI think as we get older itТs hard to control our emotions,Ф she said.
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PatientsТ pessimism can be self-fulfilling, because they may not walk to the extent they can. УTheir stride becomes shorter,Ф Dr. Morrison said. УThey donТt use their lungs.Ф
Dr. Gray-Miceli said it was important for doctors and nurses to keep the patient focused on tangible signs of progress, Уso she can say: СToday I got up by the side of the chair and took five steps. Yesterday I only took four steps.Т Ф
Ms. Aliminosa began a physical therapy regimen to build strength in her legs and upper body and improve her gait. With improvement she gained a sense of optimism and control over her body.
She said the depression returned from time to time, as did the fear of falling again. But she said: УThe thought that IТm getting better has helped a great deal. I try to think so each day, really.Ф
She smiled; she joked. On a recent morning, she groused amiably about her fitness program, but finished, with no sign of pain or exhaustion. УIТm walking,Ф she said, УI wouldnТt say to my satisfaction, because I used to be a hiker. I canТt expect that yet, but IТm hoping for it.Ф
† HYPERLINK "http://www.cdc.gov/ncipc/pub-res/toolkit/Falls_ToolKit/DesktopPDF/English/booklet_Eng_desktop.pdf" Here is a useful checklist for preventing falls at home.
Here are some fall information from the HYPERLINK "http://www.cdc.gov/ncipc/duip/preventadultfalls.htm" Centers For Disease Control.
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